Patients with severe rheumatoid arthritis more likely to have heart problems

Early menopause is risk factor, research presented at American College of Rheumatology meeting shows

People with rheumatoid arthritis and other chronic inflammatory conditions are at higher risk of heart disease. Who is in the most danger, why and how best to prevent and detect cardiovascular complications are important questions for physicians and researchers. Mayo Clinic studies presented at the American College of Rheumatology annual meeting shed new light on this connection, in part by revealing factors that seem to put some rheumatoid arthritis patients in greater jeopardy of heart problems: early menopause, more severe rheumatoid arthritis and immunity to a common virus, cytomegalovirus, among others.

In one study, Mayo researchers discovered that patients whose rheumatoid arthritis is more severe are likelier to have heart problems. That becomes true soon after rheumatoid arthritis strikes, making early treatment of rheumatoid arthritis important, says co-author Eric Matteson, M.D., chair of rheumatology at Mayo Clinic in Rochester, Minn.

"One thing that we learned in particular in this study is that the high disease burden on the joints in the first year of disease already is a very strong predictor of cardiovascular disease subsequently, and that seems to be mitigated as time goes on if the disease burden can be reduced too," Dr. Matteson says.

In other research, a Mayo team looked at a common virus called cytomegalovirus, a bug many people get and do not even know they have. They found correlations between rheumatoid arthritis patients' immune response to the virus and the development of myocardial disease.

If it turns out that there is this relationship, then it may be that one way to spot patients who are at higher risk for heart disease would be an immune profile or biomarkers related to the cytomegalovirus and its associated immune activation signaling," says Dr. Matteson, a co-author.

Another study found that women with rheumatoid arthritis and early menopause -- menopause before age 45 -- also seem to be at higher risk of heart disease. About two-thirds of patients with rheumatoid arthritis are women, and researchers have long studied possible hormonal influences on development of the disease, Dr. Matteson says.

"This study shows the complex relationship between rheumatoid arthritis, hormones and heart disease," says Dr. Matteson, the senior author. "We also found patients who have had multiple children, especially seven or more, are at higher risk of cardiovascular disease compared with women who have menopause at a normal age or have fewer children."

Other Mayo Clinic studies found:

• A higher incidence of the heart rhythm disorder, prolonged QT interval, in rheumatoid arthritis patients, particularly those who had a higher "sed rate" -- a blood test that can reveal inflammatory activity when their rheumatoid arthritis was diagnosed.

• Rheumatoid arthritis patients are likelier to develop a high uric acid level, a condition called hyperuricemia, and that is a significant predictor of peripheral arterial disease, but doesn't appear to be one for cardiovascular disease.

• Multiple risk factors for heart disease were spotted in patients when they were diagnosed with giant cell arteritis, inflammation of the lining of the arteries. However, giant cell arteritis patients do not seem to be at higher risk of acute coronary syndrome, a condition whose symptoms mirror those of a heart attack.